Three Things: Bracing for Omicron’s Overrun

[NB: check the byline, thanks. /~Rayne]

Not going to lie or mince words: the White House fucked up its response to Omicron. They let businesses, pressure from the GOP’s COVIDiots, and public polling tell them what to do instead of gaming out an effective response. They focused on the economy and then-irrational fear of inflation instead of COVID, only to create the problem they wanted to address.

While the impending COVID explosion would likely have happened anyhow, the curve could have been flattened and the blow to health care systems softened had the White House not only emphasized getting testing out to the public but getting better quality masks to the people while asking any and all public facilities conducting business indoors to ensure better air quality immediately.

You know, advocate the things which have been proven to work in other countries like Japan — a densely-populated country with a population more than a third of the U.S.’s but less than 19,000 COVID deaths to date.

But more on that in a moment.

~ 3 ~

I’ve been furious since a friend told me last week they were blindsided by someone in their social circle who has fallen prey to disinfo about COVID.

In a nutshell, their acquaintance is:

1 – Peeved about the unvaccinated being blamed for the spread of COVID;

2 – Doesn’t think the lack of vaccinations in a sizable percentage of the population caused a new variant;

3 – Feels the virus will mutate and spread whether people are vaccinated or unvaccinated;

4 – Believes vaccines will reduce severity of cases and keep hospitalizations down, but the mutations and contagion will happen anyhow.

Jesus Christ, where to even start except tell them to quit Facebook. These half-truths about COVID are truly problematic with an American public weak on science education – well, weak education as a whole, when it comes to critical thinking.

Mr. Blindsider needs to understand:

1 – The ongoing threat is the willfully unvaccinated, not those who can’t be vaccinated because of legitimate health problems or those whose circumstances have prevented them from being vaccinated. Anyone willfully choosing not to be vaccinated isn’t merely putting themselves at risk but others like children for whom we do not yet have vaccinations, and those who want but can’t get vaccinated. Fuck the willfully selfish gits and piss on your peevedness.

2 – Yes, the lack of vaccinations DID cause a variant to rise. Unvaccinated humans are pools for new variant development. More unvaccinated people means a bigger resevoir in which new variants can develop.

3 – Take a fucking look around: do you see any new variants of polio (caused by poliovirus)? Measles (measles morbillivirus)? Chicken pox (varicella-zoster virus)? All of these are infectious diseases caused by viruses for which children have been routinely vaccinated as children over decades. Because vaccination rates are above 85% of all US children, the pool of unvaccinated is too small for the viruses to develop variants. This is what needs to happen with COVID.

4– As long as the pool of willfully unvaccinated remains as large as it is, SARS-CoV-2 will have adequate opportunity to mutate and new variants will emerge. The answer is two-fold: (1) everyone must be vaccinated who can safely tolerate a tested vaccine, and (2) a better vaccine is needed, one designed to protect against all coronaviruses.

But the answer is really four-fold:

– The U.S. public school system needs to do more and better biological science education because too many adults are quite stupid when it comes to basics like infection control let alone microbiology. That education should also include new content on airborne spread of disease like measles and COVID, the latter by aerosolized particles.

– The White House needs to fix CDC and FDA communications problems, because they’re frankly doing an abysmal job this deep into a pandemic. We should not still be arguing with our neighbors 23 months into this about simple infection control and its affects on individuals and society.

~ 2 ~

Mr. Peeved Blindsider will be part of the reason Omicron explodes; they’re incapable of systems thinking necessary to enact effective mitigation, too busy folding like a broken lawn chair under disinformation and minor frustrations all of us have had to deal with.

Too busy throwing a pity party for the poor maligned willfully unvaccinated to think about what is about to erupt across the country.

Read this Twitter thread:

There were school systems across the country which didn’t have enough bus drivers under the Beta and Delta waves. This is about to happen again even though more people are vaccinated and Omicron is not as severe as Delta, because Omicron still sickens people and still forces people into quarantine and isolation.

If all schools don’t close this week, children are going to bring Omicron into classrooms, spread it to each other because they got it over the holidays, because they weren’t given N95 masks, and their schools’ HVAC systems haven’t been upgraded to improve air quality and reduce exposure time to aerosolized virus.

They will infect school teachers and staff and bus drivers, who will infect their families.

Schools will be forced to go to remote learning again for the lack of teachers and bus drivers.

Students’ and teachers’ family members will take it to work, including places like grocery stores and fast food chains and manufacturing facilities and shipping companies.

The supply chain will be throttled down again and we’ll hear yet another round of bullshit about inflationary pressures about which the right-wing and neoliberals will lie and claim the GOP can fix in spite of its ongoing anti-vaccination campaign.

Omicron may burn itself out inside 3-4 weeks, but the effects will be much longer. We still do not have data about the long-term effects of Omicron on those infected; the data will be complicated by the spectrum of unvaccinated/unvaccinated-but-previously-infected/vaccinated-only/vaccinated-and-boosted.

We can plan ahead, though, for a worst case in which those infected with Omicron have some degree of neurological sequelae and increased fatigue along with increased risk of death because we’ve seen this with previous variants. Expect more people acting irrationally or sluggishly because of COVID brain fog.

Social distancing throughout the rest of the winter may be our best approach.

Gods help us all if we need health care services for anything urgent apart from COVID.

~ 1 ~

As I wrote when I started this post, the White House fucked up the response to this variant. The Omicron scenario was always a possibility and a plan for it should have been on the books, ready for roll out. (Has no one in Centers for Disease Control and Food and Drug Administration as well as the White House done any simulations and scenario planning at all for this pandemic??)

A shorter isolation period due to Omicron’s allegedly milder symptoms combined with more rapid testing isn’t a rational response without better mitigation to flatten the curve, not to mention the assumptions made about illness severity relying on early data which could have been flawed in analysis.

Though a key component of the White House’s answer to Omicron, rapid tests simply haven’t been available at the scale of numbers and breadth of distribution this country needed. We’ve seen far too many examples of people waiting in lines for hours to get tested throughout the holiday season.

Propublica’s reporting on the clown car that is America’s COVID rapid test approval process explains much of the problem, but this should have be addressed as an emergency skunkworks in November, with the White House fully engaged with the FDA as soon as Omicron was announced.

There have also been people claiming huge quantities of rapid tests could be available inside weeks. Read that Propublica report, and then think like a manufacturer for a moment – one which has had problems with obtaining raw materials, difficulty with reliable shipments (hello, fire Louis DeJoy), and labor shortages due to illness and insufficient child/eldercare for workers.

I know people being courted for jobs in testing production; the industry literally doesn’t have enough current employees to step up production for delivery inside weeks let alone days.

Given all the barriers to adequate numbers of reliable rapid tests, heightened infection control measures are an absolute necessity.

And yet the response to Omicron has been sadly lacking emphasis on infection control – even after the absurd theater of an airline CEO sickening with COVID testifying before the Senate that masks don’t do much.

Every single American should have been mailed (7) N95 masks – one per day to use on rotation through this Omicron surge. They’re cheap, easy to ship by mail (hello, fire Louis DeJoy), don’t need special testing and approval; we have multiple manufacturers in the U.S. ready to step up production.

Every single health care worker should have received at least twice that number already. Health care facilities should be able to hand them out to patients and their families.

Every single public facility should have been ordered to improve air quality with improved ventilation; CO2 tests should have been distributed to every school for every classroom as a measure of air quality and a proxy for risk of aerosolized virus exposure. Higher CO2 levels – roughly equating to increased aerosolized particles from occupants and low air flow – should result in windows and doors being opened, addition of Corsi-Rosenthal Cube filter systems, or dismissal of classes until CO2 levels fall to acceptable levels.

Longer term, legislation providing funding for improving air quality in all public facilities should be on Congress’s agenda, because this isn’t the last variant we’ll see before this pandemic is over. There will be other reasons for improving indoor air quality – increasing numbers of wildfires and dust storms as the climate emergency deepens will be adequate justification to continue HVAC improvements.

And as I already said, something needs to be done pronto about the communications out of CDC and FDA about COVID, including infection control measures.

~ 0 ~

All that said, double down on measures to protect yourself, friends, and loved ones through this Omicron wave. Use the measures Japan’s health ministry has advocated and apparently work when used widely.

Avoid the Three Cs:
— Closed spaces with poor ventilation or unmonitored air quality
— Crowded spaces occupied by many people
— Close-contact settings which don’t allow adequate social distance

Do the Three Ws:
— Wear a better mask (N95 preferred)
— Watch your social distance to reduce exposure to aerosols
— Wash your hands to prevent spread of any infectious agents

And if you haven’t yet gotten your booster, do whatever you can to get that on board.

CDC Modeling Demonstrates Importance of Intervention in Ebola Outbreak

Helpful graphic from WHO illustrating precautions to prevent infection while traveling. Click on image to see a larger version.

Helpful graphic from WHO illustrating precautions to prevent infection while traveling. Click on image to see a larger version.

As the Ebola outbreak in West Africa continues to grow, fresh attention was focused on it yesterday when the CDC announced that in a mathematical model they developed of the outbreak, failing to intervene in spread of the virus could lead to as many as 1.4 million people infected by late January. Somewhat lost in the response to the “wow factor” of a projection of over a million people being infected is that the model also very powerfully demonstrates how the viral outbreak can be contained simply through moderate adoption of the most basic aspects of an infection control program.

First, to review from my previous Ebola post, Ebola is only transmitted when bodily fluids of infected or dead individuals come into contact with broken skin or mucous membranes.

The key to preventing spread of the virus is for those who care for infected patients, whether they are health care workers at a hospital or family members in the home, is preventing contact with fluids from the patient. CDC has prepared an informative guidance document for how health care workers can control the spread of Ebola in their facilities. The key steps are to provide protective clothing to cleaning staff, use an effective disinfectant, avoid re-use of materials with pourous surfaces and dispose (as regulated medical waste) of all textiles, linens, pillows and mattresses that may be contaminated.

Because practices such as these are routinely implemented in US health facilities when patients with high risk infectious diseases are being treated, there is little to no chance of Ebola spreading within the US. As noted in the previous Ebola post, the extreme poverty of the health care systems in the affected countries in Africa is what has allowed the disease to spread, as health care facilities there simply cannot afford the materials they need for implementing safe practices.

Here is the output of the model for Ebola spread in Liberia and Sierra Leone if infection control is not implemented beyond the current level. As noted in the NYTimes article linked above, the current estimate is that 18% of patients in Liberia and 40% of patients in Sierra Leone are treated in facilities that prevent spread of the virus. The model predicts both the number of infected patients in the two countries and the number of beds devoted to care of those patients (“corrected” means that the estimate for number of infected individuals is corrected for the assumption that 2.5 times more patients are infected than have been officially reported):
no intervention

As noted above and widely cited in the press yesterday, if the virus outbreak is left unchecked, the model predicts a cumulative total 1.4 million infected patients in the two countries by January 20 (many of whom are dead by then) and a need for up to 100,000 beds for treatment of these patients.

The good news that is buried in the CDC model is that stopping the virus outbreak does not require implementation of virus control measures for treatment of every infected patient. In the graphs below, we see the output from the model under the assumption that viral control practices start to be implemented now and expand to a level of 70% of infected patients (25% of them in hospitals and 45% in home treatment) being treated under safe practices by December:

Note that the cumulative number of cases levels off between 25,000 and 30,000 and the total number of beds needed peaks at around 13,000  1300 before dropping rapidly.

This model demonstrates very clearly that the highest priority for stopping the Ebola outbreak should be rapid and widespread implementation of basic infection control practices. Spreading this information into homes where patients are being treated is key. Convincing families of the importance of removing infected clothing and bedding seems likely to be the pivotal aspect of the public information campaign. Help from the West will be essential in providing the huge amount of disposable protective clothing and the necessary cleaning and disinfecting supplies. Replacement clothing, linens, mattresses and pillows should be provided as many of the affected families will be hard-pressed to replace these items under the already difficult conditions of an infected family member.

Further good news is that these projections were based on conditions in August and there is reason to believe that the situation may already be getting better. From the Times, again:

The caseload projections are based on data from August, but Dr. Thomas R. Frieden, the C.D.C. director, said the situation appeared to have improved since then because more aid had begun to reach the region.

“My gut feeling is, the actions we’re taking now are going to make that worst-case scenario not come to pass,” Dr. Frieden said in a telephone interview. “But it’s important to understand that it could happen.”

Let’s hope that Dr. Frieden is correct.